Chapter 20 Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Flashcards
HTN in Pregnancy
Classifications for HTN Disorders
1) Pre-existing condition (Chronic HTN)
- Protein in urine
2) HTN that presents during pregnancy (Gestational Hypertension or Pregnancy Induced Hypertension)
3) Preeclampsia (most common hypertensive disorder in pregnancy)
4) Eclampsia (onset of seizures)
5) Chronic Hypertension with superimposed preeclampsia
1, 2 and 3 can be further described as mild or severe
Chronic HTN
Blood Pressure of 140/ 90 mm Hg before pregnancy or before 20 weeks gestation
25% of women with chronic hypertension develop preeclampsia during pregnancy
Management: If BP exceeds 160/100 drug treatment is recommended
Gestational HTN (AKA Prgnenacy Induced HTN–PIH)
Hypertension that begins after the 20th week of pregnancy
BP of 140/90 or greater without Proteinuria
Must have an elevated BP on 2 occasions, six hours apart
Usually resolves by 12 weeks postpartum
Preeclampsia
Worldwide: 50,000 to 60,000 women die each year
Multisystem, vasopressive disorder that targets the
cardiac, hepatic, renal and central nervous system
Pathophysiology
- Vasospasm which results in elevated BP reducing the blood flow to the brain, liver, kidneys, placenta, and lungs.
- Decrease liver perfusion presents as epigastric pain and increased liver enzymes
- Decreased brain perfusion leads to headaches, visual disturbances, and hyperactive deep tendon reflexes (DTRs)
- Decreased kidney perfusion leads to decreased urine output
- Proteinuria of 300mg or greater in a 24-hour urine specimen
Management: Increased protein in diet
Management of Mild Preeclampsia
No signs of renal/hepatic dysfunction
Bed Rest (lateral recumbent position)
Diet: High in protein
Monitor Fetal Status
Frequent evaluation of CBC, liver enzymes, platelet levels, and clotting factors
Monitor protein in urine
Management of Severe Preeclampsia
Bed Rest (dark and quiet room to decrease stimulation)
Diet
Anticonvulsants (Magnesium Sulfate)
Corticosteroids (Betamethasone)
Fluid and Electrolyte Replacement
Antihypertensive
Signs & Symptoms that Preeclampsia is Worsening
Increasing edema
Worsening headache
Epigastric Pain
Visual Disturbances
Decreasing Urinary Output
Nausea/vomiting
Bleeding Gums
Disorientation
Generalized complaints of not feeling well
Hyperactive Reflexes
Eclampsia
BP of 160/110 mm Hg
Marked Proteinuria
Seizures
Hyperreflexia
Other symptoms may include: severe headache, generalized edema, epigastric pain, visual disturbances, cerebral hemorrhage, renal failure, HELLP
Management of Eclampsia
Assessment
Maintain Airway
Prevent Injury
- Lights off
- Limit visitors
- Pad rails and bed for seizure precutions
Magnesium Sulfate
Dilantin or other anti-convulsant
Prepare for birth
What is the cure for preeclampsia & eclampsia?
Deliver the placenta
HELLP
H: Hemolysis
EL: Elevated Liver Enzymes
LP: Low Platelet Count
IMMEDIATE DELIVERY
Variant of Preeclampsia and Eclampsia
Increased risk of cerebral hemorrhage, retinal detachment, hematoma/liver rupture, acute renal failure, disseminated intravascular coagulation (DIC), placental abruption, and maternal death
Hypertension absent in 10-15% of women with HELLP
Symptoms include: Nausea, Vomiting, flulike symptoms, epigastric pain
Misdiagnosis common (gastroenteritis, hepatitis, gallbladder disease, etc.)
Perinatal morbidity and mortality high
All women with HELLP give birth
regardless of gestational age
Lab Work Results for HELLP
anemia – low Hemoglobin
b.thrombocytopenia – low platelets. <100,000.
c. elevated liver enzymes:
-AST aspartate aminotransferase
exists within the liver cells and with
damage to liver cells, the AST levels rise
> 20 u/L.
- LDH – when cells of the liver are lysed, they
spill into the bloodstream and there is
an increase in serum. > 90 u/L
